Policy Action

Policy change for better health care for the informal sector

LSM team members represent SEWA in various policy forums to advocate for better health care systems for informal sector workers. LSM is a member of several national and international level networks and forums working to promote better health care for poor families. LSM is represented in the advisory committee on community action of the National Rural Health Mission, as board member of Public Health Foundation of India, part of the consultative process for the National Urban Health Mission, and as a member of the National Advisory Council. It was also represented in the WHO’s Commission of Social Determinants of Health and more recently in the High-level Expert Group on Universal Health Care. In addition, LSM was a founder of the midwives collective in Gujarat (Dai Sangathan) which aims to bring increased visibility and recognition of midwives.

Dai School And Sangathan:

Organizing Dais (Traditional Midwives)

In the course of its work on maternal and child health, Lok Swasthya Mandali saw the central role played by dais (traditional birth attendants / midwives) in this sphere. Even today a significant proportion of deliveries in rural areas are being conducted by dais. In 1984, SEWA decided to organize dais and strengthen their skills. SEWA worked with the dais with two main objectives:

To improve maternal and child health of SEWA members

To gain recognition for dais as self-employed workers and health service providers.

Trainings for Dais

While we saw that dais carried a vast store of indigenous knowledge regarding deliveries and related matters, we thought this knowledge and skill-base needed to be updated and some of their practices needed to be modified. Therefore Dai training sessions were started which taught them how to conduct safe and hygienic deliveries and how to identify risky deliveries that should then be referred to the doctor.

Establishment of a Dai school at Manipur, near Ahmedabad

As the benefits of education for Dais became apparent and as more and more dais sought to be trained, a need was felt to set up a formal Dai School. Another reason for this was that LSM felt that a standardized and detailed curriculum for dai education was needed.

An advisory committee for the Dai School was set up in 2000 which consisted of three obstetricians/gynecologists, Dr. Bindu Shah, Dr. Kalpana Munshi and Dr. Renuka Patwa, who is also the Director of Dai School. The school became functional in the year 2000.

Usually the dais are trained in the age group of 25 to 55 and have varying literacy levels. The curriculum and pedagogy used in the school tries to accommodate all these differences. Currently, a three-month training course is conducted by an experienced obstetrician/gynecologist, and covers all aspects of pre-natal, intra-natal and post-natal care as well as life-saving procedures. Till date, more than 3000 women have been provided training through thebDai School.

Features of the Dai school

Mobile school
A unique feature of the school is that it is also a mobile school. Training sessions in different districts of Gujarat are held in SEWA’s office in the district to make it easier for the dais to commute to the school.

Examination
An oral exam is held at the end of each course. External examiners from the state government’s district health office and private gynecologists are invited to examine the students.

Certification
SEWA issues certificates and identity cards to the dais that have been trained at SEWA Dai school in order to give them professional recognition.

Follow-up trainings
After each three-month period training, a series of follow-up trainings are scheduled for one year, every one month for the first six months and every two months for the next six months. This provides the dais opportunity to share their field experiences of implementing their new leanings with their batch-mates and teachers and also revise and strengthen their leanings.

Dai Sangathan

Keeping in line with the strategy of SEWA, dais also have been organized into cooperatives. In some cases, the cooperatives consist only of dai members, in others the cooperative has dais and health workers as members. A third category is district level associations in which the members include dais, health workers and other workers in the informal sector. These cooperatives provide a forum for the dais to collectively address their needs as a professional group of workers. Since 1993, SEWA has been struggling to get recognition from the formal system for dais as health care providers.

The key issues which the LSM has struggled for are:

Identity cards be issued to all dais.

Increase in the honorarium given to dais by the government for each delivery.

Regular skill and knowledge trainings in midwifery and health care.

A central role for dais in the RCH programme of the government and in other health services provided by the government.

Implementation of the government’s maternity schemes by dais and their organizations.

A complete kit for deliveries, with regular replenishment of disposable items, be made available to all dais.

Dai Spearhead teams

To remain in constant touch with its increasing membership, LSM has created spearhead teams of dais. These teams are trained to support the district- level organizations to enlist more dais in the membership, identify training needs and arrange to provide the required training.